An Investigation of Pregnancy Intention Disparities, Measurement, and Meanings in Hawaii and Among Native Hawaiians

Abstract

About half of all pregnancies in the United States are unintended (mistimed or unwanted), and this figure has held steady for decades despite recognition as a public health priority and efforts to reduce it. Unintended pregnancy has been associated with negative health and social outcomes for mother and child. Hawai‘i has the second highest unintended pregnancy rate in the U.S., and Native Hawaiians appear to have the highest rates of unintended pregnancy among the state’s major ethnic groups. The purpose of this dissertation was to examine unintended pregnancy in Hawai‘i, with a particular focus on Native Hawaiians, in terms of how different groups are affected (disparities), how it is assessed (measurement), and how it is conceptualized (meanings). The first of three studies used data from the Hawai‘i Pregnancy Risk Assessment Monitoring System to examine disparities by race/ethnicity and other maternal characteristics in: pregnancy intention; trying to get pregnant; discordant responses for intention and trying; contraceptive use before pregnancy; and “didn’t mind” pregnancy as a reason for contraceptive non-use. The second study examined three measures of pregnancy intention – the London Measure of Unplanned Pregnancy (LMUP), National Survey of Family Growth (NSFG) intention categories, and “trying” to get pregnant – in relation to demographic characteristics and pregnancy outcome (prenatal care vs. abortion) through a survey of pregnant women in Honolulu. With eight focus groups of Native Hawaiian women and men, the third study qualitatively described factors related to pregnancy planning and decision-making within this community. Findings from these three studies speak to the complexity of pregnancy intention and its importance to public health. Many women in Hawai‘i became pregnant when they were not intending, trying, and/or wanting to get pregnant. Furthermore, a substantial proportion of women reported ambivalence towards their pregnancies and did not use contraception despite being “at risk” for unintended pregnancy. Disparities by race/ethnicity and other demographic characteristics were significant in bivariate and multivariate analyses. Cultural factors and social norms may influence the perception and impact of unintended pregnancy among Native Hawaiians. Suggestions for further quantitative and qualitative research and other implications are described.